In early February the Human Rights Watch (HRW) published, "'They Want Docile': How Nursing Homes in the US Over-medicate People with Dementia." The inappropriate or misuse of antipsychotics, e.g., Haldol, Seroquel and Risperdal, in nursing facilities to chemically restrain nursing home patients, moreover frail and elderly seniors, has been practiced for decades. The HRW report found in 2016-2017 "massive use" or abuse, i.e., the report estimated in an average week over 179,000 long-stay nursing facility patients were administered antipsychotic drugs without a diagnosis for which the drugs are indicated or approved. Despite efforts to reduce the abuse of these medications, in part via a CMS voluntary initiative (a link to which his provided below), the practice persists, in part, because the federal government has nominally enforced regulations and enforcement measures to remedy the problem. The use of these drugs can and does cause serious patient harm. In testimony before the Congress in 2007, the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year form the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work." Listeners may recall I initially discussed this topic in December 2012 with Diana Zuckerman.
During this 36 minute discussion Ms. Flamm explains what prompted the HRW study, the study's methodology, how widespread is the practice of misuse of antipsychotics in nursing facilities, how and why they are used inappropriately, that includes the the failure to obtain free and informed consent, the federal government's inadequate enforcement of federal laws and regulations to police the problem and how this practice violates not just US laws but international human rights agreements.
Ms. Hannah Flamm is currently an immigration lawyer at The Door's Legal Services Center in New York. In 2016-2017, Ms. Flamm was New York University's School of Law Fellow at Human Rights Watch where she researched and wrote, "They Want Docile." She interned with the Southern Poverty Law Center, South Brooklyn Legal Services and Schonbrun DeSimone, an international human rights and civil rights firm. She is a graduate of NYU's School of Law and the Harvard University Kennedy School of Government. As a student she participated in NYU's Family Defense Clinic and the Harvard International Human Rights Clinic. Prior to attending law school, Ms. Flamm worked for the International Rescue Committee in Haiti.
The Human Rights Watch report is at: https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia.
Two related 2012 and 2011 DHHS Office of the Inspector General reports are at: https://oig.hhs.gov/oei/reports/oei-07-08-00151.pdf and https://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf.
Information on CMS' "National Partnership to Improve Dementia Care in Nursing Homes" is at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html.